REACHing MAGIS Program Referral Form 2022
is a program for 5th through 8th graders to help prepare them for the academic, social and spiritual challenges they may encounter as students in a college
preparatory high school setting.
The Le’Charles Bentley 5th Grade Leadership Academy
will support 35 future leaders from the Greater Cleveland Area who a
ttend Catholic, Private, and Public schools.
Student Contact Information
Faith Community (if known):
Home Street Address:
Home Phone Number (with area code):
Parent Email Address
Referrer's Contact Information
Home or Business Address:
Home or Daytime Phone Number (with area code):
Student's Academic Profile
Typical Grades (please select one):
C or lower
Student's Grade Level (2020-2021 school year):
If "other", please enter test name:
Math National %:
Reading National %:
English National %:
I am referring the student listed above because he is an African American, Latino, Asian American, Native American (AALANA) or Caucasian young man who has demonstrated academic and social potential and a commitment to grow spiritually. I believe the information provided above to be accurate.